循环肿瘤细胞联合超声造影预测乳腺癌新辅助化疗疗效

Predictive value of circulating tumor cells combined with ultrasound contrast in the efficacy of the neo-adjuvant chemotherapy for breast cancer

目的分析循环肿瘤细胞(CTCs)联合超声造影预测乳腺癌新辅助化疗疗效。方法选择临床分期III期的乳腺癌患者80例为研究对象。所有患者接受4×EC(表柔比星90 mg·m^(-2)+环磷酰胺600 mg·m^(-2))→4×T(多西他赛75 mg·m^(-2))新辅助治疗(根据分子分型可联合靶向治疗)。分别在第1次、第3次、第5次化疗前通过流式细胞术来进行外周血CTCs计数,并通过超声造影测量乳腺原发肿瘤具有活性部分的大小,比较不同时期CTCs计数及肿瘤大小的变化。结果在第1次、第3次和第5次化疗前,患者的CTCs阳性率分别为62.50%(50/80)、55.00%(44/80)和38.75%(31/80),差异存在显著的统计学意义(P<0.05);ER和PR等病理状态与CTCs阳性率无相关性(P>0.05),Her2和Ki67等病理状态与CTCs阳性率密切相关(P<0.01);循环肿瘤细胞联合超声造影预测乳腺癌新辅助化疗疗效的敏感度、特异度和准确度分别为95.00%、95.00%和96.25%,明显高于循环肿瘤细胞或超声造影预测效果(P<0.01)。结论循环肿瘤细胞联合超声造影对预测乳腺癌新辅助化疗疗效具有重要参考价值。

Objective To analyze the predictive value of circulating tumor cells(CTCs)combined with ultrasound contrast in the efficacy of the neo-adjuvant chemotherapy for breast cancer.Methods A total of 80 patients with clinical stageⅢbreast cancer diagnosed in our hospital from January 2020 to December 2020 were selected.All of them received the 4×EC(epirubicin 90 mg·m^(-2)+cyclophosphamide 600 mg·m^(-2)→4×T docetaxel 75 mg·m^(-2))neo-adjuvant therapy(being able to be combined with a targeted therapy according to molecular classifications).Peripheral blood CTCs were counted by flow cytometry before the first,third and fifth chemotherapy.The size of the active part of the primary breast tumor was measured by ultrasound contrast,and the changes of the CTCs count and tumor size in different periods were compared.Results Before the first,third and fifth chemotherapy,the positive rates of CTCs were 62.50%(50/80),55.00%(44/80)and 38.75%(31/80),respectively,showing a statistically significant differences(P<0.05).There was no correlation between the ER and PR pathological states and the positive rate of CTCs(P>0.05),while the pathological states such as Her2 and Ki67 were closely correlated with the positive rate of CTCs(P<0.01).The sensitivity,specificity and accuracy of circulating tumor cells combined with ultrasound contrast in predicting the efficacy of the neo-adjuvant chemotherapy for breast cancer were 95.00%,95.00%and 96.25%,respectively,which were significantly higher than those of circulating tumor cells or ultrasound contrast alone(P<0.01).Conclusion Circulating tumor cells combined with ultrasound contrast have an important reference value in predicting the efficacy of the neo-adjuvant chemotherapy for breast cancer.